Evidence map›Paper›PMID 33152097›Full record

ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2022

Non-traditional factors affecting referral for coronary angiography following SPECT myocardial perfusion imaging.

Shreyas Gowdar, Nasir Hussain, Alan W Ahlberg, Mohammad Elsadany, Guru N Kowlgi, David Silverman, W Lane Duvall

Abstract read
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In one paragraph

Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: single photon emission computed tomography.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Shreyas GowdarDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Nasir HussainDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Alan W AhlbergDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Mohammad ElsadanyDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Guru N KowlgiDepartment of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
David SilvermanDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
W Lane DuvallDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA. lane.duvall@hhchealth.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of myocardial perfusion imaging (MPI) in the management of coronary artery disease (CAD) is well established. Although prior studies have shown disparities in the use of invasive angiography in patients with acute MI, data on factors affecting referral to angiography post-MPI are lacking. We sought to evaluate the primary determinants of referral to invasive angiography post-MPI and specifically assess the role of non-traditional non-clinical factors such as race/ethnicity, socioeconomic factors, insurance status, and marital status.

methodsAll patients without known CAD who underwent stress SPECT MPI over 15 years were reviewed and the performance of coronary angiography within 90 days of their MPI was recorded. Multiple factors were analyzed for an association with referral to angiography, including exercise and MPI results, baseline demographics, traditional cardiac risk factors, and non-traditional factors such as ethnicity, insurance, marital and socioeconomic status. In a secondary analysis, these factors were assessed with regard to abnormal MPI results.

resultsOut of 27,895 total patients, 2,150 (7.7%) underwent invasive coronary angiography. On multivariate analysis, inpatient location, positive ECG response, and abnormal MPI results were the strongest predictors of angiography. Non-traditional factors such as race/ethnicity and insurance status had a significant association with referral to angiography with Caucasians (OR 1.42, 95% CI 1.18-1.71, P < .0001) and those with private insurance (OR 1.35, 95% CI 1.13-1.62, P = .001) or Medicare (OR 1.30, 95% CI 1.08-1.56, P = .006) having higher rates of angiography despite controlling for traditional risk factors and test results.

conclusionOur study results indicate that non-traditional factors such as race/ethnicity and insurance status influence patient management decisions and impact the performance of downstream cardiac invasive testing after stress MPI. Higher rates of angiography in Caucasians, privately insured and Medicare patients were seen despite controlling for traditional risk factors and abnormal test results. Further research is needed to better understand these disparities, especially in the current healthcare environment.

Indexed as

Coronary Artery DiseaseMyocardial Perfusion ImagingAgedCoronary AngiographyHumansMedicareReferral and ConsultationTomography, Emission-Computed, Single-PhotonUnited StatesCoronary angiographyEthnicityInsurance statusMyocardial perfusion imagingRace

Identifiers

PMID33152097

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.